ADA Dental Insurance Reform Virtual Credit Cards

Dental Insurance Reform Virtual Credit Cards

Virtual Credit Card – Claim Payment Restrictions Virtual credit card laws generally prohibit dental plans from restricting claim payment modality in which the only acceptable payment method is a credit card payment. These laws generally require plans to alert dentists of a fee requirement to access the payment and to provide alternative, non-fee payment options. For more information on dental insurance issues, visit ADA.org/dentalinsurance.

STATE LAWS

The information in this table is current as of August 2021. Listed by state, each row includes a brief summary of a state’s law along with the bill numbers that link to the respective state’s websites.

STATES SUMMARY

ALABAMA  Contracts between a health insurer and a covered health care provider shall SB 291 include the following language:

2015 “If a covered health care provider requests payment under a health insurance plan from a health insurer or its contracted vendor or a regional care organization be made using ACH electronic funds transfer, that request must be honored. Furthermore, such a request may not be used to delay or reject a transaction, or attempt to adversely affect the covered health care provider.”

 Does not prohibit or adopt any standards for other methods of electronic funds transfers outside of the Automated Clearing House (ACH) network.

 Alternative electronic funds transfer methods, including wire transfer and payment by card or otherwise through a private card network, are expressly permitted to pay a covered health care provider.

ARIZONA  Would prohibit health insurer’s enrollees from restricting the method of payment HB 2494 from the health insurer to the health care provider in which the only acceptable payment method is a credit card payment or an electronic funds transfer 2019 payment.

CONNECTICUT  Would prohibit certain health carriers from requiring a dentist to accept HB 5206 reimbursement for covered dental services by way of an electronic funds transfer or a virtual credit card. 2018

(HB 207 amended into HB 5206)

Dental Insurance Reform Virtual Credit Cards

STATES SUMMARY

GEORGIA  The bill would prohibit restrictions on methods of claims payment in which the HB 818 only acceptable payment method is a credit card payment.

2018  If initiating or changing payments to a health care provider using electronic funds transfer payments, including virtual credit card payments, insurers would have to notify the health care provider of any fees associated with a particular payment method, advise the provider of the available methods of payment, and provide clear instructions to the health care provider as to how to select an alternative payment method.

IDAHO  Requires insurers to provide one or more method of payment or reimbursement that provides the dentist 100% of the contracted amount of the payment or SB 1124 reimbursement without the dentist incurring a fee to access the payment or 2021 reimbursement.

INDIANA  Prohibits a health insurance plan from requiring a dental provider to accept virtual credit card payment methodology. HB 1079

2021  Requires that before insurers’ first payment using an electronic funds transfer payment, including a virtual claim payment, or before modifying the method of payment, they must notify the dentist of any fees associated with EFT payment other than the fees imposed by the dental provider’s financial institution and advise the dental provider of the methods of payment available under the health insurance plan.

 Insurers also must provide clear instructions to the dentist on how to select an alternate payment method.

LOUISIANA  Would prohibit dental plans from restricting methods of claims payment from the SB 73 dental plan to the dentist where a credit card payment is the only means of payment available. 2019  When claims payments are electronic funds transfers, including credit card payments, a dental plan would have to notify the dentist if any fees are associated with a particular payment method, advise the dentist of all the available methods of payment, and provide clear instructions to the dentist on how to select an alternative payment method.

Dental Insurance Reform Virtual Credit Cards

STATES SUMMARY

MARYLAND  Allows insurers to pay a claim using a credit card or an electronic funds transfer HB 639 payment method that imposes on the provider a fee or similar charge to process the payment if: 2016 (i) The insurer notifies the provider in advance of the payment that a fee will apply;

(ii) The insurer offers the provider an alternative payment method that does not impose a fee or similar charge on the provider; and

(iii) The provider elects to accept payment of the claim or a portion of the claim using the credit card or electronic funds transfer payment method.

MISSOURI  Prohibits health carriers from restricting methods of claims payment to a SB 514 method requiring the provider to pay a fee, discount the amount of their claim for reimbursement, or remit any other form of remuneration in order to redeem 2019 the amount of their claim for reimbursement.

 If a health carrier initiates or changes the method used to reimburse a health care provider requiring provider to pay a fee, discount the claim amount, or remit any other form of remuneration in order to redeem the claims payment, the health carrier or an entity acting on its behalf must notify the provider and provide clear instructions on selecting an alternative payment method.

 Requires health carriers shall allow the providers to select to be reimbursed by an electronic funds transfer through the Automated Clearing House Network.

 Makes violation of this law an unfair trade practice.

NEBRASKA  A dental insurance plan, contract, or provider network contract with a provider L 774 shall not include any restrictions on methods of claim payment for dental services in which the only acceptable payment method is a credit card payment. 2020

NORTH CAROLINA  Bill would prohibit restrictions on methods of claim payment in which the only SB 252 acceptable payment method from the insurer or entity to the provider of the dental services is a credit card payment. 2019

Dental Insurance Reform Virtual Credit Cards

STATES SUMMARY

OKLAHOMA  The bill would prohibit restrictions on methods of payment from health insurers HB 1157 to the health care provider in which the only acceptable payment method is a credit card payment. 2019  If initiating or changing payments to a health care provider using electronic funds transfer payments, including virtual credit card payments, insurers would have to notify the health care provider if any fees are associated with a particular payment method; and advise the provider of the available methods of payment and provide clear instructions to the health care provider as to how to select an alternative payment method.

OREGON  Allows insurers to pay claims using a credit card or electronic funds transfer HB 3021 payment method that imposes on the provider a fee or similar charge to process the payment if: 2015 (a) The insurer notifies the provider, in advance, of the fee or other charges associated with the use of the credit card or electronic funds transfer payment method;

(b) The insurer offers the provider an alternative payment method that does not impose fees or similar charges on the provider; and

TEXAS  Requires insurers to provide one or more methods of payment or HB 2486 reimbursement that provide the dentist 100% of the contracted amount of the payment or reimbursement and that do not require the dentist to incur a fee to 2019 access the payment or reimbursement.

 It also requires insurers to disclose on the Internet website required by law and on request of a dentist the fees, if any, associated with the methods of payment or reimbursement available under the plan or policy.

Dental Insurance Reform Virtual Credit Cards

STATES SUMMARY

UTAH  Allows health care provider to elect not to receive remittance through a credit HB 37 card or other similar arrangement.

2020  Requires insurers to permit this health care provider’s election to not to receive remittance through a credit card or other similar arrangement to apply to the health care provider’s entire practice.

 Prohibits insurer from requiring health care provider’s election to not receive remittance through a credit card or similar arrangement to be made on a patient-by-patient basis.

 Prohibits insurers from requiring health care providers or insureds to accept remittance through a credit card or other similar arrangement.

VERMONT  A health insurer or its contracted vendor shall not require a health care provider, including a dentist or ambulance service provider, to accept reimbursement by HB 88 credit card payment unless the health care provider has affirmatively elected to 2021 receive payments in this manner.

 If a health care provider, including a dentist or ambulance service provider, does not affirmatively elect to receive reimbursement by credit card payment, the health insurer or its contracted vendor shall make payments to the provider in another manner.

Disclaimer. These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based upon your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, insurance carrier). To the extent ADA has included links to any third party web site(s), ADA intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, ADA makes no representations or warranties about the information provided on those sites.